Provider Demographics
NPI:1093163438
Name:RUSSELL, DIANA L (LPN)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 DELIA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2059
Mailing Address - Country:US
Mailing Address - Phone:330-606-7590
Mailing Address - Fax:330-983-9164
Practice Address - Street 1:1068 DELIA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2059
Practice Address - Country:US
Practice Address - Phone:330-606-7590
Practice Address - Fax:330-983-9164
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN094269 MED IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse